A hands-on hands-off approach: governance of managed long-term care services in a context of rapid policy change |
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Authors: | Elizabeth Nisbet |
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Institution: | Department of Public Management, John Jay College of Criminal Justice, City University of New York, New York, NY, USA |
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Abstract: | Amidst state-level budgetary pressures and growing elderly populations, many US states have adopted managed care for home-based services funded through the Medicaid program. New York State’s managed care mandate is part of a Medicaid ‘Redesign’ targeting health outcomes, cost control, and administrative efficiency, reflecting features emphasized by both governance and New Public Management frameworks, but neither adequately captures this case. Incorporating a Polanyian perspective can elucidate this market expansion and related reactions and re-regulation. Drawing from interviews with staff of service-providing agencies, this case study reveals outcomes contrary to goals: administrative complexity, containment of care, and unexpected costs. |
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Keywords: | Governance health-care reform home care services long-term care United States |
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